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Human Factors refer to environmental, organisational and job factors, alongside individual characteristics which influence behaviour (HSE, 2022) and can inform quality improvement in teams and individuals (NHS England, nd ).
Using Human factors to guide a service review and QI plan means considering the three elements

Mr. JB is a 73-year-old gentleman who has a long-standing history of Venous leg ulcer (VLU). The chronicity of the ulcer has caused him signicant distress due to both the direct physical symptoms caused by the disease and indirectly through limitation of his activity of daily living, brought on by its management. His active lifestyle has prevented him complying with regular attendance at clinic appointments and keeping his wound dressings and bandages dry and clean. This has resulted in several wound contamination and deterioration.

Healthcare acquired pressure ulcers (PU) are a well-recognised, long standing preventable harm and historical data from the NHS Safety Thermometer suggests that in England, approximately 25,000 patients a year develop pressure ulcers.1
Whilst there is no single definitive national figure available for the cost of treating pressure related tissue injury, the estimated daily spend on pressure ulcer management in the NHS is in excess of £3.8 million1, with a yearly NHS spend of £1.4 - £2.1bn reported almost 20 years ago.2

Exomphalos (also known as omphalocele) is a condition that occurs very early in pregnancy, usually between 3 to 8 weeks of gestation. During early pregnancy the intestine develops outside of the abdominal cavity in the umbilical cord and is supposed to return to the abdomen by 10 weeks. Exomphalos is a defect in the development of the abdominal
wall that allows the intestine, and frequently the liver, to stay outside of the abdominal cavity in the sac of the umbilical cord(1).

It was recognised within the hospital Trust that there were challenges in ensuring that patients requiring wound debridement in order to progress their wounds received this in a timely and effective manor These challenges were identified by the Tissue viability Team to be due to lack of clinicians skilled in sharp debridement, ineffective mechanical debridement and patients moving from department or hospital before debridement can be administered Debridement is often described as a method of wound bed preparation, it involves the removal of necrotic material, eschar, devitalised tissue, serocrusts infected tissue, hyperkeratosis, slough, or any other type of bioburden from a wound with the objective to promote wound healing 1 A delay in the patient receiving debridement may result in delayed healing.
A novel new wound debridement gel that is safe, easy and effective to use was evaluated within the Trust to assess whether this may address some of these challenges

Chronic wounds are a significant burden to healthcare worldwide. Biomarkers such as temperature, humidity, ammonia, and carbon dioxide are involved in wound healing. Current smart wound dressings focus on monitoring a single parameter. Optical
fibre sensing technology is a lightweight, flexible, unexpensive platform that can monitor several biomarkers

Diabetes is a complex disease and the management of DFUs requires input from a wide range of clinical specialties A multidisciplinary team ( approach to DFUs is key to understanding the clinical relationship between uncontrolled diabetes, vascular compromise, foot deformity, diabetic foot infection and other related comorbidities 1 It has been estimated that 19 34 of diabetic patients will acquire foot ulceration during their life Even if these ulcers were to heal, recurrence rates continue to remain high 40 within one year after ulcer healing and 65 within five years 2 A retrospective cohort study of 130 newly diagnosed DFU patients found that as many as 45 of the ulcers may have been at risk of infection or infected on initial presentation Thirty five percent 35 of the ulcers healed within 12 months, 48 remained unhealed and 17 required amputation during the same period 3 In the UK, it has been estimated that there are 176 leg, foot or toe amputations each week, totaling just over 9000 in a year 4 This poster summarises the clinical outcomes following a 10 patient evaluation within our DFU clinic of ConvaMax ™a new superabsorbent ( dressing indicated for moderate to heavily exuding wounds

Pressure ulcers are defined as injuries to the skin and underlying tissue secondary to the deprivation of blood supply to the cells as a result of uninterrupted pressure. They are categorised according to their depth, using a validation tool namely the guidelines from the
National Pressure Ulcer Advisory Panel (NPUAP 2014). The severity of a pressure ulcer is categorised from 1-4, the latter being the most severe. There are two additional classes namely: unstageable that depicts the ulcer bed is obscured by devitalised tissue, and deep
tissue injury that relates to pressure damage under intact skin, which simulates the appearance of 'bruising'.

Moisure-associated skin damage (MASD) is a complex and commonly recognised condition. Overexposure of the skin to bodily fluids can compromise its integrity and barrier function, making it more permeable and susceptible to damage (Gray et al, 2011; Woo et al, 2017). Individuals with MASD experience persistent symptons that affect quality of life, including pain, burning and pruitis (Gray et al; 2011; Woo et al, 2017).

A project by Angelique Denys, Homeless Outreach Nurse, Bevan Healthcare CIC
Why was the project started?
Poor service accessibility and lack of trust for the patient causing late leg wound diagnosis and treatment. 
Wound care appointments are poorly attended by people experiencing homelessness suffering from wound and tissue concerns because of: traumatic experience of homelessness (trimorbidity), stigma related to the presentation, poor attitude of care staff when dealing with patients in the acute setting, pain and discomfort during dressing changing and application, poor wound care planning and venous ulceration diagnosis.